Mountains of foreign aid sits at the Port au Prince airport melting in
hot sun. Meanwhile, Team Rubicon is en route to set up another field
hospital at The Little Sisters of the Sacred Heart of Jesus at Delmas 18

Former Army SF Medic Mark Hayward of Team Rubicon provides this update:

100118 Haiti

I
have seen more truly grotesque and horrible injuries in the last 24
hours than I have seen previously in my entire medical career.

Using
information from the Jesuit Refugee Service, our team loaded the
available medical supplies onto two small pickup trucks and rolled from
the Novitiate to the southern part of the city. We had been informed
that there was a refugee/displaced person camp with about 900 people
including a number of injured. We drove through the city, again seeing
a generally orderly populace, with PNH managing the lines and traffic
jams at locations like a tanker truck distributing free fresh water
from the Dominican Republic, and gas stations with long lines despite
very high prices. We got to the displacement area (N18d31.529’ by
W72d19.167’ if anyone wants to find it on Google Earth), which was
simply a small park in a hillside neighborhood where most of the houses
had collapsed or were badly damaged by the quake. It was very crowded
but again orderly. No one mobbed us, no one yelled or fought. The
locals were happy to see us, took us to a shaded area that had been
cleared of tents (there are an incredible number of WalMart red Ozark
Trail tents being used by displaced families; a brilliant use of scarce
relief funds and my hat is off to whoever provided them). The locals
brought a dozen chairs, there were neighborhood people who had
volunteered to act as medical translators, we broke out our equipment
and organized a little supply area/treatment area/micropharmacy, and
started seeing patients.

The
first patient I saw was a young man of 18 years. I asked him his name,
joked with him as I unwrapped the slightly stained gauze bandage
covering his right hand. He held his hand cocked oddly at the wrist
and the dressing was bulky and strangely lumpy. I kept soaking and
peeling layers and I couldn’t understand why I wasn’t getting to his
hand. The bandages were gray-green and had an odd smell. Since I’m
not a complete idiot, I eventually realized that he was missing his two
middle fingers. However, when I peeled off the last layer of bandages,
I was appalled to see that he had sustained a traumatic amputation
which had progressed to gangrene in the six DAYS that he had waited for
basic medical care. I cleaned him up as best I could, dressed his
wounds, started him on antibiotics that MIGHT arrest the infection in
time for him to lose only his hand and wrist but save his forearm. I
asked him his name three times because I didn’t want to forget it, so
that I could pray for him and commend him to you for your prayers. I
DID find out that he was left-handed (thank God!), and I sat him down
in a shady area while Dave and Jim got on the phone and starting using
all their connections to find a hospital where he could be taken so
that someone could cut off his right hand. I was a little rattled,
but I like to think I maintained a good professional demeanor. And I
got back in line and started unwrapping the next patient.

I
will not describe in much detail the rest of the day. I can only
assume that it was like Christmas in hell. The number of rotting,
crushed, deformed limbs I unwrapped was ridiculous. If any
statisticians are reading this, our team has estimated that we saw
roughly 200 or more patients today. About 100 had simple fractures,
about 100 had wounds ranging from merely severe and painful, to grossly
infected and frankly gangrenous. We set aside five patients for
special treatment, meaning that their injuries were so severe that they
required either amputation (hands) or orthopedic surgery (fractured
femur, fractured pelvis).

Our
technique for wound care was simple. First, soak off the bandages (if
there were any). Second, wash/debride the wound with chlorhexidine
gluconate (purple and viscous, like warm grape jelly). Third, remove
any foreign debris. As an aside, foreign debris in this case means
chunks of cement. Everything in Haiti is built of cement and I don’t
recall seeing more than a handful of wounds that lacked the obligatory
cement fragments, from the size of large sand grains to small peas.
Fourth, cover the wound liberally with silver sulfadiazene cream (“the
paste”). Fifth, dress the wound with sterile gauze and clean gauze
wraps (Again, God bless Saint Mary’s hospital!). Sixth, educate the
patient on wound care and oral antibiotic therapy. Repeat. and
repeat. and repeat.

For
variety, mix this with crushed and broken limbs. Lots of lower
leg/ankle and forearm fractures. Ortho-glass? Too bad; we didn’t have
any. Instead, we used sticks and cardboard boxes. Jeff and Craig, our
firefighters, were our designated splint team. A doctor or PA would
identify a fracture (clinically -- no Xrays), describe its presumed
location, and the fire guys would build a splint. Every one was a
snowflake -- no two alike and each one a work of art. We’d send the
patient off to find a stick so they could be non-weight-bearing for six
weeks -- without crutches. Or sling, or swath, or just build something
that looked like it might work, and pray. (Did that a lot, actually.)

Tired
of that? Figure out the best antibiotic for the patient based on the
wound. How rotten is it? Oral antibiotics only, please. If it’s just
sick and oozing pale green mucus, they get Augmentin. If it’s only
festering, just silvadene cream, because we’re running out of
antibiotics already. If it’s in between, guess and pray. Five days’
therapy to conserve supplies. The kid’s only four; we need Augmentin
suspension because those leg wounds are extensive and look really
nasty. The kid’s memorable because he’s the only one who screams. He
does scream a lot. But then again, we don’t have any anesthetics. Or
narcotics. Or IVs. Or, for that matter, very much of anything. The
baby over there needs ophthalmic antibiotic ointment. Do we have
that? Dammit, dammit, damn-- hey, wait! We have TWO tubes in my
tactical eye kit in the “advanced medical bag” (otherwise known as my
American Tourister carry-on)! Asking patients “does this hurt? Are
you OK?” Yes, they agree, it hurts. Thank you for coming to help me.
Just tell me before you do ‘that’ again (debride, pack, pull traction,
whatever). Thank you for coming to help me.

Our
team is unbelievable. Combat Marines are scrubbing away at wounds,
joking with patients through volunteer interpreters. We got a new team
member this morning, Edmund, a novice Jesuit monk from Vancouver.
Since he studied Shaolin karate as a kid, he is, of course, our Shaolin
monk. I tell him to stick with me and bring me things. Within 30
minutes he is debriding and dressing wounds with minimal supervision.
He also speaks French, so he interprets when we have more patients than
volunteer interpreters. None of the patients complain. None of them
ask for a meal tray and a Sierra Mist. None of them tell me they are
allergic to every medication except Dilaudid. They are humble and
quiet and stoic and grateful and injured. I will never say anything
disparaging about “Haitians” as a group again.

Brother
Jim, on non-Shaolin monk, mixes patient care with provider care. He
makes us drink water, eat a granola bar. We are running out of
everything. Well, more accurately, that’s pretty much where we
started. Fortunately, we are also (incredibly) running out of
patients. Or at least running low on patients. We have a few
stragglers who are in bad shape (midshaft displaced angulated humeral
fracture? Yeah, that one merits another call to a hospital). We force
Jim to take a break and hydrate. We turn our backs and he is up again
looking after patients. Finally, with a sense of shame, we call a halt
to our operations: we have to shut things down so we can get back to
the novitiate house.

We’ve
planned our return travel, but we did not realize we would be evac’ing
patients. We catch a lucky break when one of the critically injured
patients is able to have his wife borrow his cousin’s car. She drives
him and two others to the hospital, including the young man with the
gangrenous right hand. We are down to two patients who can’t travel by
car: the guy with the femur fracture and the kid with the fractured
pelvis. They are both litter-only, or, since we don’t have litters,
door- and tabletop-only. Did I mention we are in a hilltop
neighborhood? The kid with the pelvis fracture is about 13 and
obviously in considerable pain. We give him some ibuprofen. Too bad
it’s not Vicodin. Dave and Will and Jim are dialing for dollars again
on their cellphones, trying to find hospitals that will take these
patients, trying to find vehicles that can carry a kid lying on a
closet door with his lower extremities “secured” with sheets. I talk
to him and crack jokes in really bad French. He laughs, then bites his
lip because laughing REALLY hurts. We find a ride for the guy with the
femur fracture. I’m hanging out with the kid. Divine inspiration
strikes and I pull out my iPhone. Within minutes he has not only
figured out how to play the “Flight of the Hamsters” game app, but he
has beaten all my high scores. I cheer him on as he sends hamsters
into the stratosphere. A little cloud of other boys gathers at the
head of his door to watch him play. Frankly, they look a little
envious. When we arrange ourselves around his door like pallbearers to
lift him up and carry him downhill, he continues playing. He is still
playing when we load him into some guy’s car to get him to the
hospital. I apologize for stealing his iPhone before he leaves. He
laughs and says “thank you.” Away he goes.

We
arrange our own transportation, now in darkness. We are taking some
calculated risks in our security planning, but there’s no sense of
hostility from the locals. Frankly they seem a little puzzled. It’s
as though we are some quirk of nature, as random as the earthquake: we
show up, we provide medical care, we go away. And in fact we do go
away, winding our way through the rubble-strewn streets, back to the
novitiate house and a home-cooked meal. The displaced persons are
divvying up a shipment of humanitarian rations (“donated by the US”) as
we depart their encampment. There’s minimal pushing or arguing.
People clear obstacles from our path and say “merci” as we leave.

I think about it after we get back to the novitiate. I think about it
after a meal of spaghetti with hot dog slices and ketchup, and a sponge
bath in a pan of well water. I think about it after a CISD led by
Brother Jim and an AAR led by Brother Jake. It’s all just weird. I
consider being angry at a long list of people. I AM angry at the
wastefulness of it all. Losing your hand or foot in Haiti is an
economic death sentence. If we’d been here four days ago with SOAP AND
WATER we could have saved limbs. If we had casting material and
crutches we could have prevented what are guaranteed to be a number of
deformities. And if we hadn’t showed up at all, things would have been
worse. I give up trying to make sense of it and I sit down to write
the name of the young man with the injured hand so that I can commend
him to you for your prayers and consideration.

At this point, with a profound sadness, I realize that despite all my efforts, I have forgotten his name.

Comments

Mountains of foreign aid sits at the Port au Prince airport melting in
hot sun. Meanwhile, Team Rubicon is en route to set up another field
hospital at The Little Sisters of the Sacred Heart of Jesus at Delmas 18

Former Army SF Medic Mark Hayward of Team Rubicon provides this update:

100118 Haiti

I
have seen more truly grotesque and horrible injuries in the last 24
hours than I have seen previously in my entire medical career.

Using
information from the Jesuit Refugee Service, our team loaded the
available medical supplies onto two small pickup trucks and rolled from
the Novitiate to the southern part of the city. We had been informed
that there was a refugee/displaced person camp with about 900 people
including a number of injured. We drove through the city, again seeing
a generally orderly populace, with PNH managing the lines and traffic
jams at locations like a tanker truck distributing free fresh water
from the Dominican Republic, and gas stations with long lines despite
very high prices. We got to the displacement area (N18d31.529’ by
W72d19.167’ if anyone wants to find it on Google Earth), which was
simply a small park in a hillside neighborhood where most of the houses
had collapsed or were badly damaged by the quake. It was very crowded
but again orderly. No one mobbed us, no one yelled or fought. The
locals were happy to see us, took us to a shaded area that had been
cleared of tents (there are an incredible number of WalMart red Ozark
Trail tents being used by displaced families; a brilliant use of scarce
relief funds and my hat is off to whoever provided them). The locals
brought a dozen chairs, there were neighborhood people who had
volunteered to act as medical translators, we broke out our equipment
and organized a little supply area/treatment area/micropharmacy, and
started seeing patients.

The
first patient I saw was a young man of 18 years. I asked him his name,
joked with him as I unwrapped the slightly stained gauze bandage
covering his right hand. He held his hand cocked oddly at the wrist
and the dressing was bulky and strangely lumpy. I kept soaking and
peeling layers and I couldn’t understand why I wasn’t getting to his
hand. The bandages were gray-green and had an odd smell. Since I’m
not a complete idiot, I eventually realized that he was missing his two
middle fingers. However, when I peeled off the last layer of bandages,
I was appalled to see that he had sustained a traumatic amputation
which had progressed to gangrene in the six DAYS that he had waited for
basic medical care. I cleaned him up as best I could, dressed his
wounds, started him on antibiotics that MIGHT arrest the infection in
time for him to lose only his hand and wrist but save his forearm. I
asked him his name three times because I didn’t want to forget it, so
that I could pray for him and commend him to you for your prayers. I
DID find out that he was left-handed (thank God!), and I sat him down
in a shady area while Dave and Jim got on the phone and starting using
all their connections to find a hospital where he could be taken so
that someone could cut off his right hand. I was a little rattled,
but I like to think I maintained a good professional demeanor. And I
got back in line and started unwrapping the next patient.

I
will not describe in much detail the rest of the day. I can only
assume that it was like Christmas in hell. The number of rotting,
crushed, deformed limbs I unwrapped was ridiculous. If any
statisticians are reading this, our team has estimated that we saw
roughly 200 or more patients today. About 100 had simple fractures,
about 100 had wounds ranging from merely severe and painful, to grossly
infected and frankly gangrenous. We set aside five patients for
special treatment, meaning that their injuries were so severe that they
required either amputation (hands) or orthopedic surgery (fractured
femur, fractured pelvis).

Our
technique for wound care was simple. First, soak off the bandages (if
there were any). Second, wash/debride the wound with chlorhexidine
gluconate (purple and viscous, like warm grape jelly). Third, remove
any foreign debris. As an aside, foreign debris in this case means
chunks of cement. Everything in Haiti is built of cement and I don’t
recall seeing more than a handful of wounds that lacked the obligatory
cement fragments, from the size of large sand grains to small peas.
Fourth, cover the wound liberally with silver sulfadiazene cream (“the
paste”). Fifth, dress the wound with sterile gauze and clean gauze
wraps (Again, God bless Saint Mary’s hospital!). Sixth, educate the
patient on wound care and oral antibiotic therapy. Repeat. and
repeat. and repeat.

For
variety, mix this with crushed and broken limbs. Lots of lower
leg/ankle and forearm fractures. Ortho-glass? Too bad; we didn’t have
any. Instead, we used sticks and cardboard boxes. Jeff and Craig, our
firefighters, were our designated splint team. A doctor or PA would
identify a fracture (clinically -- no Xrays), describe its presumed
location, and the fire guys would build a splint. Every one was a
snowflake -- no two alike and each one a work of art. We’d send the
patient off to find a stick so they could be non-weight-bearing for six
weeks -- without crutches. Or sling, or swath, or just build something
that looked like it might work, and pray. (Did that a lot, actually.)

Tired
of that? Figure out the best antibiotic for the patient based on the
wound. How rotten is it? Oral antibiotics only, please. If it’s just
sick and oozing pale green mucus, they get Augmentin. If it’s only
festering, just silvadene cream, because we’re running out of
antibiotics already. If it’s in between, guess and pray. Five days’
therapy to conserve supplies. The kid’s only four; we need Augmentin
suspension because those leg wounds are extensive and look really
nasty. The kid’s memorable because he’s the only one who screams. He
does scream a lot. But then again, we don’t have any anesthetics. Or
narcotics. Or IVs. Or, for that matter, very much of anything. The
baby over there needs ophthalmic antibiotic ointment. Do we have
that? Dammit, dammit, damn-- hey, wait! We have TWO tubes in my
tactical eye kit in the “advanced medical bag” (otherwise known as my
American Tourister carry-on)! Asking patients “does this hurt? Are
you OK?” Yes, they agree, it hurts. Thank you for coming to help me.
Just tell me before you do ‘that’ again (debride, pack, pull traction,
whatever). Thank you for coming to help me.

Our
team is unbelievable. Combat Marines are scrubbing away at wounds,
joking with patients through volunteer interpreters. We got a new team
member this morning, Edmund, a novice Jesuit monk from Vancouver.
Since he studied Shaolin karate as a kid, he is, of course, our Shaolin
monk. I tell him to stick with me and bring me things. Within 30
minutes he is debriding and dressing wounds with minimal supervision.
He also speaks French, so he interprets when we have more patients than
volunteer interpreters. None of the patients complain. None of them
ask for a meal tray and a Sierra Mist. None of them tell me they are
allergic to every medication except Dilaudid. They are humble and
quiet and stoic and grateful and injured. I will never say anything
disparaging about “Haitians” as a group again.

Brother
Jim, on non-Shaolin monk, mixes patient care with provider care. He
makes us drink water, eat a granola bar. We are running out of
everything. Well, more accurately, that’s pretty much where we
started. Fortunately, we are also (incredibly) running out of
patients. Or at least running low on patients. We have a few
stragglers who are in bad shape (midshaft displaced angulated humeral
fracture? Yeah, that one merits another call to a hospital). We force
Jim to take a break and hydrate. We turn our backs and he is up again
looking after patients. Finally, with a sense of shame, we call a halt
to our operations: we have to shut things down so we can get back to
the novitiate house.

We’ve
planned our return travel, but we did not realize we would be evac’ing
patients. We catch a lucky break when one of the critically injured
patients is able to have his wife borrow his cousin’s car. She drives
him and two others to the hospital, including the young man with the
gangrenous right hand. We are down to two patients who can’t travel by
car: the guy with the femur fracture and the kid with the fractured
pelvis. They are both litter-only, or, since we don’t have litters,
door- and tabletop-only. Did I mention we are in a hilltop
neighborhood? The kid with the pelvis fracture is about 13 and
obviously in considerable pain. We give him some ibuprofen. Too bad
it’s not Vicodin. Dave and Will and Jim are dialing for dollars again
on their cellphones, trying to find hospitals that will take these
patients, trying to find vehicles that can carry a kid lying on a
closet door with his lower extremities “secured” with sheets. I talk
to him and crack jokes in really bad French. He laughs, then bites his
lip because laughing REALLY hurts. We find a ride for the guy with the
femur fracture. I’m hanging out with the kid. Divine inspiration
strikes and I pull out my iPhone. Within minutes he has not only
figured out how to play the “Flight of the Hamsters” game app, but he
has beaten all my high scores. I cheer him on as he sends hamsters
into the stratosphere. A little cloud of other boys gathers at the
head of his door to watch him play. Frankly, they look a little
envious. When we arrange ourselves around his door like pallbearers to
lift him up and carry him downhill, he continues playing. He is still
playing when we load him into some guy’s car to get him to the
hospital. I apologize for stealing his iPhone before he leaves. He
laughs and says “thank you.” Away he goes.

We
arrange our own transportation, now in darkness. We are taking some
calculated risks in our security planning, but there’s no sense of
hostility from the locals. Frankly they seem a little puzzled. It’s
as though we are some quirk of nature, as random as the earthquake: we
show up, we provide medical care, we go away. And in fact we do go
away, winding our way through the rubble-strewn streets, back to the
novitiate house and a home-cooked meal. The displaced persons are
divvying up a shipment of humanitarian rations (“donated by the US”) as
we depart their encampment. There’s minimal pushing or arguing.
People clear obstacles from our path and say “merci” as we leave.

I think about it after we get back to the novitiate. I think about it
after a meal of spaghetti with hot dog slices and ketchup, and a sponge
bath in a pan of well water. I think about it after a CISD led by
Brother Jim and an AAR led by Brother Jake. It’s all just weird. I
consider being angry at a long list of people. I AM angry at the
wastefulness of it all. Losing your hand or foot in Haiti is an
economic death sentence. If we’d been here four days ago with SOAP AND
WATER we could have saved limbs. If we had casting material and
crutches we could have prevented what are guaranteed to be a number of
deformities. And if we hadn’t showed up at all, things would have been
worse. I give up trying to make sense of it and I sit down to write
the name of the young man with the injured hand so that I can commend
him to you for your prayers and consideration.

At this point, with a profound sadness, I realize that despite all my efforts, I have forgotten his name.

Search

The Authors

Former Paratrooper and Army Officer, "Blackfive" started this blog upon learning of the valorous sacrifice of a friend that was not reported by the journalist whose life he saved. Email: blackfive AT gmail DOT com

Instapinch
Bill Paisley, otherwise known as Pinch, is a 22 year (ongoing) active and
reserve naval aviator. He blogs over at www.instapinch.com on a veritable
cornucopia of various and sundry items and will bring a tactical naval
aviator's perspective to Blackfive. Readers be warned: any comments of or
about the F-14 Tomcat will be reverential and spoken in low, hushed tones.
Email: wpaisley AT comcast DOT net

Mr. Wolf has over 26 years in the Army, Army NG, and USAR. He’s Airborne with 5 years as an NCO, before becoming an officer. Mr. Wolf has had 4 company commands. Signal Corp is his basic branch, and Public Affairs is his functional area. He recently served 22 straight months in Kuwait and Iraq, in Intel, PA, and senior staff of MNF-I. Mr. Wolf is now an IT executive. He is currently working on a book on media and the Iraq war. Functional gearhead.

In Iraq, he received the moniker of Mr. Wolf after the Harvey Kietel character in Pulp Fiction, when "challenges" arose, they called on Mr. Wolf...
Email: TheDOTMrDOTWolfAT gmail DOT com

Deebow is a Staff Sergeant and a Military Police Squad Leader in the Army National Guard. In a previous life, he served in the US Navy. He has over 19 years of experience in both the Maritime and Land Warfare; including deployments to Southwest Asia, Thailand, the South Pacific, South America and Egypt. He has served as a Military Police Team Leader and Protective Services Team Leader and he has served on assignments with the US State Department, US Air Force Security Police, US Army Criminal Investigation Division, and the US Drug Enforcement Administration. He recently spent time in Afghanistan working with, training and fighting alongside Afghan Soldiers and is now focused on putting his 4 year Political Science degree to work by writing about foreign policy, military security policy and politics.

McQ has 28 years active and reserve service. Retired. Infantry officer. Airborne and Ranger. Consider my 3 years with the 82nd as the most fun I ever had with my clothes on. Interests include military issues and policy and veteran's affairs.
Email: mcq51 -at - bellsouth -dot- net

Tantor is a former USAF navigator/weapon system officer (WSO) in F-4E Phantoms who served in the US, Asia, and Europe. He is now a curmudgeonly computer geek in Washington, DC, picking the taxpayers pocket. His avocations are current events, aviation, history, and conservative politics.

Twenty-three years of Active and Reserve service in the US Army in SF (18B), Infantry and SOF Signal jobs with operational deployments to Bosnia and Africa. Since retiring he's worked as Senior Defense Analyst on SOF and Irregular Warfare projects and currently ensconced in the emerging world of Cyberspace.

The Authors Emeritus

Major Pain --
A Marine who began his blog in Iraq and reflects back on what he learned there and in Afghanistan. To the point opinions, ideas and thoughts on military, political and the media from One Marine’s View.Email: onemarinesview AT yahoo DOT com

Uber Pig was an Infantryman from late 1991 until early 1996, serving with Second Ranger Battalion, I Corps, and then 25th Infantry Division. At the time, the Army discriminated against enlisted soldiers who wanted use the "Green to Gold" program to become officers, so he left to attend Stanford University. There, he became expert in detecting, avoiding, and surviving L-shaped ambushes, before dropping out to be as entrepreneurial as he could be. He is now the founder of a software startup serving the insurance and construction industries, and splits time between Lake Tahoe, Boonville, and San Francisco, CA.

Uber Pig writes for Blackfive a) because he's the proud brother of an enlisted Civil Affairs Reservist who currently serves in Iraq, b) because he looks unkindly on people who make it harder for the military in general, and for his brother in particular, to succeed at their missions and come home in victory, and c) because the Blackfive readers and commenters help keep him sane.

COB6 spent 24 years in the active duty Army that included 5 combat tours with service in the 1st Ranger Battalion and 1st Special Forces Group . COB6 was enlisted (E-7) and took the OCS route to a commission. COB6 retired a few years back as a field grade Infantry officer.
Currently COB6 has a son in the 82nd Airborne that just returned from his third tour and has a newly commissioned daughter in the 4th Infantry Division.